Extended-spectrum β-lactamase and carbapenemase-producing bacteria urinary tract infections in adult HIV-positive outpatients at Embu County Referral Hospital, Kenya
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Date
2025-11
Journal Title
Journal ISSN
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Publisher
Springer Nature
Abstract
Abstract
Background Antimicrobial resistance (AMR) poses a significant threat to public health, with the Global Action Plan
advocating, among others, for strengthening AMR knowledge and evidence base through surveillance and research
and optimizing the use of antimicrobial medicines in human and animal health. However, due to inadequate healthcare infrastructure in many resource-constrained countries, epidemiological data to inform infection prevention interventions and guide antimicrobial policy guidelines in people living with HIV is limited. Here, we assessed the prevalence, antimicrobial resistance, and associated factors of bacterial urinary tract infections among adult HIV-positive
outpatients in our study setting.
Methods This was a hospital-based cross-sectional study among adult HIV-positive outpatients at Embu County
Referral Hospital, Kenya, from January to February 2023. We consecutively recruited 142 patients presenting
with or without UTI symptoms and excluded those aged below 18. Demographic and clinical data were collected
using a pretested questionnaire, and midstream-clean-catch urine samples were processed by standard microbiological methods.
Results The overall prevalence of UTI was 9.9% (95% confidence interval (CI): 4.96–14.76% (14/142), with 6.3% symptomatic [95% CI: 2.33–10.35% (9/142)], 3.5% asymptomatic [95% CI: 0.49–6.55% (5/142)], and 4.2% recurrent [95% CI:
0.92–7.53% (6/142)] UTIs. Klebsiella pneumoniae was predominant overall (57.1%, 8/14), and in asymptomatic (80%,
4/5) and recurrent (66.7%, 4/6) UTIs. All the isolates were multidrug-resistant, with 36% (5/14) as meropenem-resistant
and 14.3% (2/14) of carbapenem-resistant K. pneumoniae were colistin-resistant. E. coli isolates were susceptible
to meropenem, amikacin, ciprofloxacin, and levofloxacin. The lowest resistance in K. pneumoniae was in amikacin
(12.5%) and colistin (25%). Notably, 79% (11/14) and 35.7% (4/14) of the isolates were extended-spectrum β-lactamase
(ESBL) and carbapenemase producers, respectively. Those with recurrent UTI were at higher odds of having UTI
[adjusted odds ratio: 7.37, 95% CI: 1.93—28.07 (p=0.003)].
Conclusions Our findings highlight a high prevalence of bacterial urinary tract infections, including recurrent
ones caused by ESBL-, carbapenemase-producing, and colistin-resistant bacteria among HIV-infected adults.
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Research Article
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Citation
Kiongo, N. K., Maingi, J. M., Nyongesa, K. W., & Musyoki, A. M. (2025). Extended-spectrum β-lactamase and carbapenemase-producing bacteria urinary tract infections in adult HIV-positive outpatients at Embu County Referral Hospital, Kenya. BMC Microbiology, 25, 743. https://doi.org/10.1186/s12866-025-03872-1